Improving physician-nurse communication and teamwork using SBAR

Leadership at Puget Sound Healthcare, a nursing home in Olympia, Washington, identified physician-nurse communication and teamwork as an important focus for their quality improvement efforts. Commonly, physicians are off-site when nurses contact them about an emerging medical issue, making communication and collaboration especially challenging.

Qualis Health facilitated a leadership session on how structured communication and flattened hierarchy can improve communication effectiveness. Using a “learning conversation” structured communication approach (format: what I observe, think, feel and want), the physicians wanted to see nurses more effectively communicate patient status. Nurses reported delays and inefficiencies with the current communication system, sometimes spanning into the next shift. All felt frustrated and wanted to improve teamwork.

During the session, the group discussed differences in communication styles. Physicians are trained to be problem solvers, and nurses are trained to be narrative and descriptive. Dr. Kirk Dawson, Medical Director, noted, “In medical school, physicians learn to use SOAP to communicate case facts, assessment and patient plan of care. I can see SBAR as a parallel approach for nursing staff.”

The traditional model of communication might have been “I’m calling about Mr. Smith, he’s short of breath.” Then the conversation becomes a game of 20 questions until they come up with a plan that may or may not be mutually acceptable. SBAR requires problem solving, organization of information before communicating, and collaboration.

Why SBAR?

• Ensures completeness of information
• Sets expectations that flatten hierarchy—makes it okay for staff to say what they think is going on and make a recommendation
• Standardization makes communication less “random” or person-dependent

The team conducted a small test. Allison Paquette, the director of nursing, asked Qualis Health to provide an in-service to the three nurse managers on day shift. All nurse managers strongly agreed that the SBAR training was valuable, well organized and could be applied to their work. A huddle at the end of shift indicated that nurses successfully applied their training. Wendy Wincewicz, RN, used SBAR on a call to Dr. Laura Lindsay, Medical Director, who declared, “You’re using SBAR!” Puget Sound is now implementing SBAR facility-wide with all nurses, all shifts to receive training in February. SBAR is appropriate for any situation in which background is shared and a decision is to be made:

• Critical conversations requiring immediate action
• Problem situations
• Telephone communication between clinical professional and MD

Communication effectiveness at Puget Sound Healthcare is monitored through structured interviews with staff, observations and formal satisfaction surveys. The team is evaluating the current system for contacting physicians off-site for possible improvements in efficiency as well.

For more information about SBAR, see the Institute of Healthcare Improvement's free webinar IHI on Demand: Effective Teamwork as a Care Strategy—SBAR and Other Tools for Improving Communication between Caregivers. (You will be asked to set up a user account and password.)